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Evaluation of the International Study Group of Pancreatic Surgery definition of delayed gastric emptying after pancreatoduodenectomy in a high-volume centre

Published on Apr 28, 2010in British Journal of Surgery 5.43
· DOI :10.1002/bjs.7071
Thilo Welsch5
Estimated H-index: 5
(University Hospital Heidelberg),
M. Borm1
Estimated H-index: 1
(University Hospital Heidelberg)
+ 3 AuthorsMoritz N. Wente4
Estimated H-index: 4
(University Hospital Heidelberg)
Abstract
Background: Delayed gastric emptying (DGE) is a common complication after pancreatoduodenectomy. The International Study Group of Pancreatic Surgery (ISGPS) definition of DGE has not been evaluated and validated in a high-volume centre. Methods: Complete data sets including assessment of gastric emptying were identified from a database of patients undergoing pancreatoduodenectomy between 2001 and 2008. Factors associated with DGE (grades A, B and C) were assessed by univariable and multivariable analyses. Results: DGE occurred in 340 (44·5 per cent) of 764 patients. Median hospital stay was significantly prolonged in patients with DGE: 13, 21 and 40 days for grades A, B and C respectively versus 11 days for patients without DGE. DGE was associated with prolonged intensive care unit (ICU) admission (at least 2 days): 20·6, 28·6 and 61·8 per cent of those with grades A, B and C respectively versus 9·4 per cent of patients without DGE. Factors independently influencing DGE grade A were female sex, preoperative heart failure and major complications (grade III–V). Validation of the DGE definition revealed that DGE grades A and B were associated with interventional treatment in 20·1 and 44·4 per cent of patients. Conclusion: The ISGPS DGE definition is feasible and applicable in patients with an uneventful postoperative course. Major postoperative complications and ICU treatment, however, might limit its usefulness. The identified risk factors for DGE are not amenable to perioperative improvement. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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  • Citations (83)
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References32
Newest
Published on Nov 1, 2009in Surgery 3.57
Joon Seong Park22
Estimated H-index: 22
(Yonsei University),
Ho Kyoung Hwang15
Estimated H-index: 15
(Yonsei University)
+ 4 AuthorsHoon Sang Chi19
Estimated H-index: 19
(Yonsei University)
Background Delayed gastric emptying (DGE) is one of the most common complications after pancreatoduodenectomy (PD). Because an objective, universally accepted definition of DGE does not yet exist, it is impossible to compare complication rates and outcomes of new operative approaches, operative techniques, and clinical trials. The International Study Group of Pancreatic Surgery (ISGPS) has proposed a universal classification for DGE based on clinical outcomes, but this classification has not bee...
83 Citations Source Cite
Published on Jun 1, 2009in American Journal of Surgery 2.14
David Fuks28
Estimated H-index: 28
,
Guillaume Piessen24
Estimated H-index: 24
+ 14 AuthorsLaurence Chiche26
Estimated H-index: 26
(UNICAEN: University of Caen Lower Normandy)
Abstract Background Pancreatic fistula (PF) is one of the most common postoperative complications of pancreatoduodenectomy (PD). A recent International Study Group on Pancreatic Fistula (ISGPF) definition grades the severity of PF according to the clinical impact on the patient's hospital course. Although PF is generally treated conservatively (grade A), some cases may require interventional procedures (grade B) or may be life-threatening and necessitate emergency reoperation (grade C). The aim ...
160 Citations Source Cite
Published on Jun 1, 2009in Annals of Surgery 9.20
Emi Akizuki7
Estimated H-index: 7
,
Yasutoshi Kimura36
Estimated H-index: 36
+ 4 AuthorsKoichi Hirata54
Estimated H-index: 54
Objective: A prospective consecutive study was planned to evaluate the postpancreaticoduodenectomy (PD) oral intake tolerance. The occurrence of delayed gastric emptying (DGE), as defined by the International Study Group of Pancreatic Surgery (ISGPS), and the amount of dietary intake were analyzed. The risk factors for low oral intake tolerance were additionally determined. Summary Background Data: The causation of DGE after PD is still unclear. Several possible factors have been discussed, such...
69 Citations Source Cite
Published on Mar 1, 2008in World Journal of Surgery 2.77
Wande B. Pratt17
Estimated H-index: 17
(BIDMC: Beth Israel Deaconess Medical Center),
Mark P. Callery46
Estimated H-index: 46
(BIDMC: Beth Israel Deaconess Medical Center),
Charles M. Vollmer38
Estimated H-index: 38
(BIDMC: Beth Israel Deaconess Medical Center)
Background: The International Study Group on Pancreatic Fistula (ISGPF) classification scheme has become a useful system for characterizing the clinical impact of pancreatic fistula. We sought to identify predictive factors that predispose patients to fistula, specifically those with clinical relevance (grades B/C), and to describe the clinical and economic significance of risk stratification within this framework.
205 Citations Source Cite
Published on Dec 1, 2007in Indian Journal of Surgery 0.51
Shailesh V. Shrikhande30
Estimated H-index: 30
(Heidelberg University),
Jörg Kleeff69
Estimated H-index: 69
(TUM: Technische Universität München)
+ 1 AuthorsHelmutFriess79
Estimated H-index: 79
(TUM: Technische Universität München)
While mortality following pancreaticoduodenectomy has progressively decreased over the last decade, its morbidity, especially the development of pancreatic fistula, has remained constant over the years. However, high volume centers and individual surgeons report a major decrease in the rate of post-operative pancreatic fistulas. Technical refinements are crucial to reduce, and if possible prevent, the development of pancreatic fistula. No uniformity of opinion exists as to the method of pancreat...
7 Citations Source Cite
Published on Nov 1, 2007in Surgery 3.57
Moritz N. Wente36
Estimated H-index: 36
(Heidelberg University),
Claudio Bassi79
Estimated H-index: 79
(University of Verona)
+ 9 AuthorsL. William Traverso39
Estimated H-index: 39
(Virginia Mason Medical Center)
Background Delayed gastric emptying (DGE) is one of the most common complications after pancreatic resection. In the literature, the reported incidence of DGE after pancreatic surgery varies considerably between different surgical centers, primarily because an internationally accepted consensus definition of DGE is not available. Several surgical centers use a different definition of DGE. Hence, a valid comparison of different study reports and operative techniques is not possible. Methods After...
1,002 Citations Source Cite
Published on Sep 1, 2007in Pancreatology 2.76
Tingbo Liang24
Estimated H-index: 24
(ZJU: Zhejiang University),
Xueli Bai18
Estimated H-index: 18
(ZJU: Zhejiang University),
Shusen Zheng41
Estimated H-index: 41
(ZJU: Zhejiang University)
Aims: The aim of the study is to validate a new classification of pancreatic fistula (PF) and to document risk factors for PF. Methods: A retrospective study was
40 Citations Source Cite
Published on Aug 1, 2007in Annals of Surgery 9.20
James T. McPhee18
Estimated H-index: 18
,
Joshua S. Hill17
Estimated H-index: 17
+ 5 AuthorsJennifer F. Tseng36
Estimated H-index: 36
Pancreatic cancer remains the fourth leading cause of cancer deaths overall in the United States, killing an estimated 31,800 people in 2005.1 A number of single-institution and single-state reports have described an improvement in perioperative mortality in the 1980s and 1990s for high-risk cancer resections, including pancreaticoduodenectomy (PD).2–4 In the state of Maryland, concurrent with a move toward statewide regionalization of PD, a decrease in perioperative mortality was described over...
309 Citations Source Cite
Published on Jul 1, 2007in Surgery 3.57
Moritz N. Wente36
Estimated H-index: 36
(Heidelberg University),
Johannes Veit5
Estimated H-index: 5
(Heidelberg University)
+ 9 AuthorsMichael G. Sarr85
Estimated H-index: 85
(Mayo Clinic)
Background Postoperative hemorrhage is one of the most severe complications after pancreatic surgery. Due to the lack of an internationally accepted, universal definition of postpancreatectomy hemorrhage (PPH), the incidences reported in the literature vary considerably, even in reports from randomized controlled trials. Because of these variations in the definition of what constitutes a PPH, the incidences of its occurrence are not comparable. Methods The International Study Group of Pancreatic...
730 Citations Source Cite
Published on Jun 25, 2007in Journal of Gastrointestinal Surgery 2.81
Pascal O. Berberat34
Estimated H-index: 34
(Heidelberg University),
H. Ingold1
Estimated H-index: 1
(Heidelberg University)
+ 6 AuthorsMarkus W. Büchler125
Estimated H-index: 125
(Heidelberg University)
Concepts in “fast-track” surgery, which provide optimal perioperative care, have been proven to significantly reduce complication rates and decrease hospital stay. This study explores whether fast-track concepts can also be safely applied and improve the outcomes of major pancreatic resections. Perioperative data from 255 consecutive patients, who underwent pancreatic resection by means of fast-track surgery in a high-volume medical center, were analyzed using univariate and multivariate models....
95 Citations Source Cite
Cited By83
Newest
Monica M. Dua13
Estimated H-index: 13
(Stanford University),
Anand Navalgund1
Estimated H-index: 1
+ 6 AuthorsBrendan C. Visser27
Estimated H-index: 27
(Stanford University)
Limited clinical indicators exist after pancreaticoduodenectomy to allow prediction of delayed gastric emptying (DGE). This study introduces a novel, noninvasive, wireless patch system capable of a...
Source Cite
Published on Nov 1, 2018in Journal of Surgical Research 2.05
Sowmya Narayanan4
Estimated H-index: 4
(UVA: University of Virginia),
Allison N. Martin4
Estimated H-index: 4
(UVA: University of Virginia)
+ 3 AuthorsVictor M. Zaydfudim10
Estimated H-index: 10
(UVA: University of Virginia)
Abstract Background Safety of pancreaticoduodenectomy has improved significantly in the past 3 decades. Current inpatient and 30-d mortality rates are low. However, incidence and causes of 90-d and 1-y mortality are poorly defined and largely unexplored. Methods All patients who had pancreaticoduodenectomy between 2007 and 2016 were included in this single institution, retrospective cohort study. Distributions of pancreaticoduodenectomy-specific morbidity and cause-specific mortality were compar...
1 Citations Source Cite
Published on Oct 1, 2018in JAMA Surgery 8.50
Jae Pil Jung1
Estimated H-index: 1
(University of Pittsburgh),
Mazen S. Zenati27
Estimated H-index: 27
(University of Pittsburgh)
+ 4 AuthorsMelissa E. Hogg15
Estimated H-index: 15
(University of Pittsburgh)
Importance Technical proficiency at robotic pancreaticoduodenectomy (RPD) and video assessment are promising tools for understanding postoperative outcomes. Delayed gastric emptying (DGE) remains a major driver of cost and morbidity after pancreaticoduodenectomy. Objective To determine if technical variables during RPD are associated with postoperative DGE. Design, Setting, and Participants A retrospective study was conducted of technical assessment performed in all available videos (n = 192) of...
2 Citations Source Cite
Published on Sep 11, 2018in Zentralblatt Fur Chirurgie 0.42
Jessica Hafke , Cornelius van Beekum + 3 AuthorsTim R. Glowka5
Estimated H-index: 5
Hintergrund Die Magenentleerungsstorung (MES) ist die haufigste Komplikation nach partieller Pankreatoduodenektomie. Wahrend eine ante- oder retrokolische Lage keinen Einfluss auf die Haufigkeit einer MES hat, wurde wiederholt postuliert, dass eine infrakolische im Gegensatz zur suprakolischen Duodenoenterostomie durch die gestreckte Position des Magenausgangs vorteilhaft ist. Beide Formen der retrokolischen Rekonstruktion wurden bislang nicht miteinander verglichen. Patienten 138 Patienten wurd...
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Published on Dec 1, 2017in Pancreatology 2.76
Jason Wang1
Estimated H-index: 1
(Austin Hospital),
Ronald Ma1
Estimated H-index: 1
(Austin Hospital)
+ 4 AuthorsLaurence Weinberg15
Estimated H-index: 15
(University of Melbourne)
Abstract Background/Objectives Pancreaticoduodenectomy (PD), also known as a Whipple procedure, is commonly performed for a variety of benign and malignant tumours, including of the pancreatic head and surrounding structures. PD is associated with low mortality but high morbidity and costs. Our objective was to describe the financial burden of complications following pancreaticoduodenectomy. Methods We searched for articles using the MEDLINE, EMBASE, Cochrane and EconLit databases from the year ...
4 Citations Source Cite
Published on Dec 1, 2017in Hpb 3.13
Jason Wang1
Estimated H-index: 1
(University of Melbourne),
Ronald Ma1
Estimated H-index: 1
+ 6 AuthorsLaurence Weinberg15
Estimated H-index: 15
(University of Melbourne)
Abstract Background A cost analyses of complications following pancreaticoduodenectomy (PD) was performed in a high volume hepato-biliary-pancreatic service. We hypothesised that costs are increased with both severity and number of complications; we investigated the relationship between complications and specific cost centres. Methods 100 patients from 2011 to 2016 were included. Data relating to their perioperative course were collected. Complications were documented by the Clavien–Dindo classi...
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Published on Dec 1, 2017in Nutrition Journal 3.57
Théophile Guilbaud2
Estimated H-index: 2
(AMU: Aix-Marseille University),
David Jérémie Birnbaum6
Estimated H-index: 6
(AMU: Aix-Marseille University)
+ 6 AuthorsVincent Moutardier29
Estimated H-index: 29
(AMU: Aix-Marseille University)
Background Delayed gastric emptying (DGE) is the most frequent pancreatic specific complication (PSC) after pancreaticoduodenectomy (PD). Several gastric decompression systems exist to manage DGE. Patients with a pancreatic tumor require prolonged nutrition; however, controversies exist concerning nutrition protocol after PD. The aim of the study was to assess the safety and efficacy of nasogastric (NG), gastrostomy (GT), and gastrojejunostomy (GJ) tubes with different feeding systems on postope...
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Published on Sep 1, 2017in Pancreas 2.96
Chloé Vandermeeren , Patrizia Loi8
Estimated H-index: 8
,
Jean Closset28
Estimated H-index: 28
Source Cite
Rajesh Panwar4
Estimated H-index: 4
(AIIMS: All India Institute of Medical Sciences),
Sujoy Pal17
Estimated H-index: 17
(AIIMS: All India Institute of Medical Sciences)
Background A number of definitions have been used for delayed gastric emptying (DGE) after pancreatoduodenectomy and the reported rates varied widely. The International Study Group of Pancreatic Surgery (ISGPS) definition is the current standard but it is not used universally. In this comprehensive review, we aimed to determine the acceptance rate of ISGPS definition of DGE, the incidence of DGE after pancreatoduodenectomy and the effect of various technical modifications on its incidence. Data ...
2 Citations Source Cite